Nose: Septorhinoplasty

Septorhinoplasty

Indications

Nasal blockage due to combined septal/nasal pyramid deformity

Reconstruction of post-traumatic nasal deformity

Reconstruction of complex congenital deformities such as facial clefts

Aesthetic improvement

NB Indications for septorhinoplasty and rhinoplasty are limited by NHS policies, as well as private insurance provider policies. Purely aesthetic (septo)rhinoplasty is limited to self-funding patients in the private sector.

Procedure

Depending on the modifications required, septorhinoplasty can be performed endonasally (without external incisions), and open (with a small incision across the columella).

The nasal skin and soft tissue is degloved from the underlying cartilage and bone. The shape of the bones and cartilage are altered by excision, reshaping, suturing and osteotomies. Augmentation may be carried out using cartilage from the septum, pinna or rib, or using artificial materials.

Length of procedure

A wide range from 1 to 3 or more hours, depending on complexity.

Complications

NB Rhinoplasty is complex and individual: consent should be taken by the operating surgeon.

Pain

Bleeding

Infection

Unsatisfactory cosmetic result

Blockage

Deformity

Septal perforation

Anosmia

Need for revision surgery (usually quoted as 10%)

Skin changes

Numbness

Scar

Post-operative management

The patient will often have an external nasal cast or internal splint postoperatively. These are removed in clinic around one or more weeks later: check the operation note.

Most patients will go home the same day, although a few may stay overnight.

In external approach septorhinoplasty, skin sutures may need to be removed at 5-7 days.

TTO

Analgesia, usually with saline/alkaline nasal douche. Chlorampenicol (eye) ointment to be applied to nostrils and skin incision (if present). Some surgeons will give prophylactic antibiotics.